Children's Hospital Colorado

Sore Throat

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

  • Pain or discomfort of the throat
  • Made worse when swallows
  • Rare symptom before 2 years old
  • Not caused by an injury to the throat

Causes of Sore Throat

  • Colds. Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours. Then a cough and runny nose occur.
  • Viral Pharyngitis. Some viruses cause a sore throat without other symptoms. A cough and runny nose don't become part of the illness. An antibiotic won't help.
  • Strep Pharyngitis. Group A Strep is the most common bacterial cause. It accounts for 20% of sore throats without any cold symptoms. Pus is seen on the tonsils. Peak age is 5 to 15 years. An antibiotic is helpful.
  • Mono. Infectious Mono mainly occurs in teens and young adults. The main symptoms are sore throat, fever and widespread swollen lymph nodes. Like Strep, Mono also has pus on the tonsils. Patients with Mono also may have a large spleen. It's located in the upper left side of the stomach. Mono is diagnosed with special blood tests.
  • Post-nasal Drip. Drainage from a sinus infection can cause a sore throat. The throat clearing that goes with the drainage may cause most of the irritation. The sinus infection is more likely to be viral than bacterial.
  • Mouth Breathing. Breathing with the mouth open during sleep can cause a sore throat. After eating breakfast, it often goes away.
  • Abscess of Tonsil (Serious). A bacterial infection of the tonsil can spread to the surrounding tissues. The main symptoms are severe trouble swallowing, fever and one-sided throat pain. It's also hard to fully open the mouth. The peak age is teens.
  • Epiglottitis (Very Serious). A bacterial infection of the flap of tissue above the vocal cords. It normally covers the windpipe during swallowing. The main symptoms are severe sore throat, drooling, spitting and fever. It can shut off the airway. Needs a 911 response.

Strep Throat: When to Suspect

  • Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.
  • Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat. These symptoms point more to a viral cause.
  • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
  • Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.
  • If you think your child has Strep, call your doctor.
  • Your doctor will do a Strep test. If the test is positive, they will start treatment. There is no risk from waiting until a Strep test can be done.
  • Standard treatment is with antibiotics by mouth.

Symptoms in Infants and Toddlers

  • Children less than 2 years of age usually don't complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Their symptoms are usually better covered using Drinking Fluids - Decreased care guide.

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • You think your child has a life-threatening emergency

Go to ER Now

  • Can't swallow any fluids and new onset drooling

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe
  • Great trouble swallowing fluids or spit
  • Can't open mouth all the way
  • Stiff neck
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Purple or blood-colored spots or dots on skin
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent. (Note: a Strep test alone is not urgent)

Call Doctor Within 24 Hours

  • Sore throat pain is severe and not better 2 hours after taking ibuprofen
  • Large lymph nodes in the neck
  • Pink rash that's widespread
  • Earache or ear drainage
  • Sinus pain (not just congestion) around cheekbone or eyes
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • Age less than 2 years old
  • Close contact to a person with Strep within last 7 days
  • Sores on the skin
  • You think your child needs to be seen, but the problem is not urgent (or needs a Strep test)

Call Doctor During Office Hours

  • Sore throat is the main symptom and lasts more than 48 hours
  • Sore throat with cold/cough symptoms lasts more than 5 days
  • You have other questions or concerns

Self Care at Home

  • Viral throat infection suspected

Care Advice for Sore Throats

  1. What You Should Know About Sore Throats:
    • Most sore throats are just part of a cold and caused by a virus.
    • A cough, hoarse voice or nasal discharge points to a cold as the cause.
    • Most children with a sore throat don't need to see their doctor.
    • Here is some care advice that should help.
  2. Sore Throat Pain Relief:
    • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice.
    • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
    • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
    • Medicated throat sprays or lozenges are generally not helpful.
  3. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  4. Fever Medicine:
    • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Note: Fevers less than 102° F (39° C) are important for fighting infections.
    • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
  5. Fluids and Soft Diet:
    • Try to get your child to drink adequate fluids.
    • Goal: Keep your child well hydrated.
    • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
    • Solid Foods: Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solid foods.
    • Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.
  6. Return to School:
    • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
    • Most often, having just a sore throat is not a reason to miss school.
    • Children with Strep throat need to be taking an antibiotic for 24 hours.
  7. What to Expect:
    • Most often, sore throats with a viral illness last 4 or 5 days.
  8. Call Your Doctor If:
    • Sore throat is the main symptom and lasts more than 48 hours
    • Sore throat with a cold lasts more than 5 days
    • Fever lasts more than 3 days or goes above 104° F (40° C)
    • You think your child needs to be seen
    • Your child becomes worse

Care Advice for Sore Throats

Scarlet Fever Rash

The photo shows the typical Scarlet Fever rash on the forearm.

The scarlet fever rash first appears as tiny red bumps on the chest and abdomen that may spread all over the body. Looking like a sunburn, it feels like a rough piece of sandpaper, and lasts about 2-5 days.

Scarlet fever is a disease caused by the same bacteria (Streptococcus) that causes strep throat. A person with Scarlet fever has a throat that is red and sore, usually a fever, usually swollen glands in the neck, and a Scarlet fever rash.

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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Copyright 2000-2018. Schmitt Pediatric Guidelines LLC.

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